Efficacy of bismuth for antibiotic-resistant Helicobacter pylori strains eradication: A systematic review and meta-analysis
Abstract
Abstract Background & Aims Antibiotic resistance of Helicobacter pylori ( H. pylori ) is increasing worldwide, and bismuth quadruple therapy has been recommended as a first‐line regimen in many areas. This study aimed to investigate whether bismuth would improve the eradication rate (ER) of clarithromycin‐/metronidazole‐/levofloxacin‐resistant H. pylori strains and how much additional efficacy bismuth could achieve. Methods PubMed, EMBASE, Web of Science, and Cochrane Central databases for randomized controlled trials were systematically searched by two independent reviewers until 15 January 2022. Pooled ERs of clarithromycin‐/metronidazole‐/levofloxacin‐resistant H. pylori strains were compared between bismuth‐containing and non‐bismuth therapies. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using a random‐effects model. Results Eight studies enrolling 340 individuals were included. The RRs of pooled ERs compared between bismuth‐containing and non‐bismuth therapies were 1.83 for clarithromycin‐resistant strains (95% CI 1.16–2.89, pooled ER: 76.9% vs. 36.6%, p = .009, I 2 = 0%), 1.39 for metronidazole‐resistant strains (95% CI 1.09–1.78, pooled ER: 86.8% vs. 60.9%, p = .008, I 2 = 37%), 2.75 for dual clarithromycin/metronidazole‐resistant strains (95% CI 1.01–7.52, pooled ER: 76.9% vs. 18.2%, p = .05, I 2 = 0%), and 1.04 for levofloxacin‐resistant strains (95% CI 0.56–1.93, pooled ER: 63.4% vs. 54.3%, p = .90; I 2 = 60%). Bismuth significantly…
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Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 340 participants or records.
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